Is home where the heat is? comparing residence-based with mobility-based measures of heat exposure in San Diego, California

International audienceBackground: Heat can vary spatially within an urban area. Individual-level heat exposure may thus depend on an individual's day-to-day travel patterns (also called mobility patterns or activity space), yet heat exposure is commonly measured based on place of residence.Objective: In this study, we compared measures assessing exposure to two heat indicators using place of residence with those defined considering participants' day-to-day mobility patterns.Methods: Participants (n = 599; aged 35-80 years old [mean =59 years]) from San Diego County, California wore a GPS device to measure their day-to-day travel over 14-day intervals between 2014-10-17 and 2017-10-06. We measured exposure to two heat indicators (land-surface temperature [LST] and air temperature) using an approach considering their mobility patterns and an approach considering only their place of residence. We compared participant mean and maximum exposure values from each method for each indicator.Results: The overall mobility-based mean LST exposure (34.7 °C) was almost equivalent to the corresponding residence-based mean (34.8 °C; mean difference in means = -0.09 °C). Similarly, the mean difference between the overall mobility-based mean air temperature exposure (19.2 °C) and the corresponding residence-based mean (19.2 °C) was negligible (-0.02 °C). Meaningful differences emerged, however, when comparing maximums, particularly for LST. The mean mobility-based maximum LST was 40.3 °C compared with a mean residence-based maximum of 35.8 °C, a difference of 4.51 °C. The difference in maximums was considerably smaller for air temperature (mean = 0.40 °C; SD = 1.41 °C) but nevertheless greater than the corresponding difference in means.Impact: As the climate warms, assessment of heat exposure both at and away from home is important for understanding its health impacts. We compared two approaches to estimate exposure to two heat measures (land surface temperature and air temperature). The first approach only considered exposure at home, and the second considered day-to-day travel. Considering the average exposure estimated by each approach, the results were almost identical. Considering the maximum exposure experienced (specific definition in text), the differences between the two approaches were more considerable, especially for land surface temperature

Well-being at school. A public problem

International audienc

Vers une approche systémique de la santé à l’école : travailler les conditions et leviers de déploiement

CommentaireInternational audienceL’école constitue un déterminant majeur de la santé des enfants, des adolescents, mais également, en tant qu’environnement de travail, des professionnels qui la fréquentent. La littérature internationale montre tout l’intérêt d’aller vers une approche socio-écologique du milieu de vie scolaire, considérant les liens et les interactions inextricables des différents déterminants contribuant à la réussite scolaire et à la santé des élèves à court, moyen et long termes, ainsi qu’au bien-être des adultes encadrants, enseignants et familles. En France, la mise en œuvre de cette approche constitue un changement de paradigme, passant d’une approche centrée sur le dépistage systématique de pathologies et la transmission d’informations à une approche systémique, considérant l’école dans toute sa complexité. Dans cette perspective, ce commentaire s’intéresse au niveau macro des politiques publiques, au niveau méso des établissements scolaires et au niveau micro des personnes fréquentant ces établissements

Wildfire Smoke Exposure and Incident Dementia

International audienceImportance Long-term exposure to total fine particulate matter (PM 2.5 ) is a recognized dementia risk factor, but less is known about wildfire-generated PM 2.5 , an increasingly common PM 2.5 source. Objective To assess the association between long-term wildfire and nonwildfire PM 2.5 exposure and risk of incident dementia. Design, Setting, and Participants This open cohort study was conducted using January 2008 to December 2019 electronic health record (EHR) data among members of Kaiser Permanente Southern California (KPSC), which serves 4.7 million people across 10 California counties. KPSC members aged 60 years or older were eligible for inclusion. Members were excluded if they did not meet eligibility criteria, if they had a dementia diagnosis before cohort entry, or if EHR data lacked address information. Data analysis was conducted from May 2023 to May 2024. Exposures Three-year rolling mean wildfire and nonwildfire PM 2.5 in member census tracts from January 2006 to December 2019, updated quarterly and estimated via monitoring and remote-sensing data and statistical techniques. Main Outcome and Measures The primary outcome was incident dementia, identified using diagnostic codes in the EHR. Odds of dementia diagnoses associated with 3-year mean wildfire and nonwildfire PM 2.5 exposure were estimated using a discrete-time approach with pooled logistic regression. Models adjusted for age, sex, race and ethnicity (considered as a social construct rather than as a biological determinant), marital status, smoking status, calendar year, and census tract–level poverty and population density. Stratified models assessed effect measure modification by age, sex, race and ethnicity, and census tract–level poverty. Results Among 1.64 million KPSC members aged 60 years or older during the study period, 1 223 107 members were eligible for inclusion in this study. The study population consisted of 644 766 female members (53.0%). In total, 319 521 members identified as Hispanic (26.0%), 601 334 members identified as non-Hispanic White (49.0%), and 80 993 members received a dementia diagnosis during follow-up (6.6%). In adjusted models, a 1-μg/m 3 increase in the 3-year mean of wildfire PM 2.5 exposure was associated with an 18% increase in the odds of dementia diagnosis (odds ratio [OR], 1.18; 95% CI, 1.03-1.34). In comparison, a 1-μg/m 3 increase in nonwildfire PM 2.5 exposure was associated with a 1% increase (OR, 1.01; 95% CI, 1.01-1.02). For wildfire PM 2.5 exposure, associations were stronger among members less than 75 years old upon cohort entry, members from racially minoritized subgroups, and those living in high-poverty vs low-poverty census tracts. Conclusions and Relevance In this cohort study, after adjusting for measured confounders, long-term exposure to wildfire and nonwildfire PM 2.5 over a 3-year period was associated with dementia diagnoses. As the climate changes, interventions focused on reducing wildfire PM 2.5 exposure may reduce dementia diagnoses and related inequities

Exploring sub-threshold food addiction in adult patients with severe obesity: a cross-sectional analysis

International audienceBackground - Most studies on Food Addiction (FA) used the strict classical diagnosis approach without quantifying sub-threshold symptoms (i.e. uncontrolled/excessive food intake, negative affect, craving, tolerance, withdrawal, and continued use despite harm) nor indicating where they stand on the "three-stage addiction cycle" modeling the transition from substance use to addiction. Objectives - (1) to estimate the proportion of clinically significant episodes of distress/impairment in severely obese patients without FA, and (2) to assess their associations with FA symptoms at the subthreshold level. Methods - The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) assesses 11 symptoms (diagnostic criteria) plus clinically significant impairment and distress (clinical significance criterion). We used this tool to diagnose FA (≥ 2 criteria plus clinical significance) in adult patients with severe obesity, but included only those below the threshold in the analyses. Demographics, clinical features, and obesity complications were collected. Results - Only 18% of the 192 participants (women  = 148, 77.1%; mean age: 43.0 ± 13.2) reported a total absence of FA symptoms, while one in four reported recurrent episodes of clinically significant distress (24%) or impairment (25%) in social, occupational, or other important areas of functioning. The most common recurrent symptoms were first-stage symptoms (binge/intoxication), while second- (withdrawal/negative affect) and third-stage (preoccupation/anticipation) symptoms affected nearly one patient in five for tolerance and craving, and one in ten for withdrawal. In multivariate analysis, impairment was positively related to withdrawal and tolerance, while distress was positively related to failure in role obligations. Conclusion - Many patients with severe obesity experience recurrent episodes of FA symptoms at the subthreshold level. Prospective studies will examine whether these symptoms may play a causal role in symptoms progression toward a full-blown FA and obesity outcomes

Kinetic analysis of TCPP emission from fireproofed upholstered furniture under realistic indoor conditions

Pre-print : https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4925260.International audienceBetter understanding the characteristics and mechanisms governing the indoor emissions of organophosphorus flame-retardants is important to more accurately estimate the human exposure to these compounds and develop risk management strategies that protect human health. This study provides an analysis of short- and long-term trends in Tris(chloropropyl)phosphate (TCPP) emissions from furniture. It is based on the monitoring over a period of almost one year of TCPP concentrations in indoor air and at the surface of a source material (upholstered furniture made of polyurethane (PU) foam containing TCPP) in two rooms for office use. The emission rate was estimated at 8 µg.m-2.h-1 in average with no decline trend observed after about one year's emission. The released mass of TCPP over one year represented about 0.2 % of the initial content of TCPP in the material (2 % w/w). The source material/air partition coefficient (Kma) and its dependence on temperature appear to be the key parameters which control the emission rate. Kma was estimated at 8 × 107 for a temperature of 23 °C. The temperature dependence of Kma was addressed using the Clausius–Clapeyron relationship and the enthalpy of partitioning between the source material and air, ΔHma (previously estimated at 91 kJ mol−1). This study led to the development of a model providing predictions on the long-term trend in TCPP emission from the source material. The simulations showed that the emission should persist over extended periods (several years) with the same intensity level. This characteristic increases the risks associated with inhalation exposure to TCPP

Time to care: How a homecare model harnesses nurses’ professional ethic and cultivates caring

International audienceBackground A persistent devaluation of care-work, difficult working conditions, and low salaries have led to challenges with staff recruitment and retention in the homecare sector in France. A new homecare organization adopting an innovative organizational model recently experimented an hourly payment method yielding positive outcomes. Objectives Using Tronto’s caring framework, this paper analyzes the strategies used by the founders as they developed their innovative model and the nursing activities performed during home visits. Design A longitudinal qualitative study was conducted between 2017 and 2023. Homecare nursing teams were shadowed for 1–2 days per year yielding detailed field notes on caregiving activities, both before and after the new payment method. Secondary data included reports, videos, articles, and unpublished documents found online. Ethical considerations While there is no requirement in France to obtain ethical approval in non-interventional research, verbal consent was obtained by all participants prior to their involvement in the study; confidentiality and anonymity were strictly maintained; and pseudonyms were assigned to protect identities. Findings 63 interviews and 185 h of shadowing and observations were conducted. Results revealed a virtuous cycle of caring facilitated and encouraged by new incentives that resonated with nurses’ professional ethics. The favorable working environment and the hourly payment method enabled nurses to provide caregiving in accordance with their values. Conclusions As the new hourly payment experiment is scaled-up nationally, it is imperative that it is not isolated from the organizational model. Without the underpinning values and principles, the hourly payment method alone is unlikely to shift the value attributed to caring

Looking for pathogens in dust from North Africa arriving in the French West Indies using metabarcoding and cultivable analysis

International audiencePeriodically, the French West Indies receive dust originating from North Africa (NA). Microorganisms associated with desert dust can be transported over long distances through the atmosphere and could represent a means for the remote colonization of new habitats by putatively pathogenic microorganisms. The aim of this study was to determine the diversity and frequency of microbial agents (bacteria, eukaryotes) in NA dusts and the potential threat toward human and/or animal health by comparing microbial air composition during dust events and in control samples. In 2017 and 2018, 16 samples were collected during seven NA dust episodes and there were 9 controls. The microbial composition of the samples was characterized using a cultivable approach and by metabarcoding analyses (16S and 18S). A greater bacterial load and greater diversity were observed during the dust events, and some genera were significantly associated with the events. Some, such as Geodermatophilus, can be considered signature species of NA dust. No pathogenic species were found with the cultivable approach, whereas the metabarcoding analyses highlighted the presence of several potentially pathogenic species or known human pathogens such as Naegleria fowleri

Current evidence gaps to support systematic cytomegalovirus screening in pregnancy

International audienceThe benefits of screening for cytomegalovirus (CMV) infection during pregnancy remain a topic of debate. To date, no randomized trial has compared the impact of screening versus routine management on the prevention of severe sequelae in newborns. Furthermore, it is unclear what actions can be taken in case of a positive screening given that there is limited evidence of effective interventions as no treatments showed significant effect on the frequency of congenital cytomegalovirus infections and, as additional challenge, the window for effective treatment initiation after maternal infection is narrow, estimated to be as short as five weeks. Universal screening of all pregnant women could lead to a high number of false positives. There are also concerns regarding the cost-effectiveness of universal screening and the capacity of healthcare professionals that may struggle to manage the increased workload, and we argue that the conditions for implementing such a programme are not yet met. In this Viewpoint we aim at highlighting these challenges and stimulating the forthcoming discussion on how to fill the gaps before CMV screening in pregnancy could be adopted as a standard practice

Overcoming Barriers: Trajectories for a School Environment That Promotes the Participation of Adolescents with Chronic Conditions

International audienceThe characteristics of the school environment can influence students’ participation. Therefore, exploring the existing barriers to school participation and academic success of students with chronic conditions (CCs) is essential since they are a population at an increased risk for impairments and difficulties in these areas. This specific study aimed to explore the personal and school-environment variables associated with the school participation of students with CCs. Additionally, it aimed to analyze the differences between (1) male and female adolescents concerning the impact of CCs on school participation and the personal and school-environment variables; and (2) adolescents with and without school participation affected by the existing CCs regarding personal and school-environment variables. This work included 1442 adolescents with CCs, 56.3% female (n = 769), with a mean age of 15.17 years (SD = 2.33), participating in the Health Behavior in School-Aged Children (HBSC) 2022 study. The results showed that girls and students with school participation affected by CCs are at greater risk regarding the personal and school-environment variables under study. In the multivariable logistic regression analysis of the association between these variables and the school participation of students with CCs, a greater weight of personal variables was observed, followed by those of the school environment related to interpersonal relationships and, finally, the physical environment and safety-at-school variables. The study highlights the relevance of considering the existing barriers to school participation and academic success of students with CCs. The results also underline the importance of aligning the intervention of health and education professionals and policymakers. All of these professionals must make a joint effort to overcome existing barriers in the school context and move towards an increasingly balanced environment that promotes and protects the equal participation of all students